Culture

OAK BROOK, Ill. - In response to the critical shortage of nasopharyngeal (NP) swabs early in the COVID-19 pandemic, the Department of Radiology at University of South Florida (USF) Health in Tampa set out to design, validate and create NP swabs using a point-of-care 3D printer. Results of the first clinical trial of 3D-printed NP swabs for COVID-19 testing are being presented at the annual meeting of the Radiological Society of North America (RSNA).

"To date, USF Health has printed more than 100,000 3D NP swabs, and hospitals around the world have used our 3D files to print tens of millions more swabs for point-of-care use," said Summer Decker, Ph.D., associate professor, vice chair for research, and director of the 3D Clinical Applications for the Department of Radiology in the USF Health Morsani College of Medicine and Tampa General Hospital.

The 3D swab has received national and international recognition as an example of the power of medical 3D printing and quick innovation to provide clinical solutions.

The flocked NP swab, which collects a test sample of nasal secretions from the back of the nose and throat for lab analysis, is the current standard of care for diagnosing COVID-19. It consists of a narrow plastic rod and a tip covered in a flocked polyester material.

"COVID-19 appears first in the nasopharyngeal regions and from there it's inhaled into the respiratory system," Dr. Decker explained.

As the pandemic and demand for COVID-19 testing surged in early March, Dr. Decker and her team immediately began studying how they could develop an alternative to the flocked swab.

"We collaborated with our colleagues in infectious disease, virology, emergency medicine and radiology as well as Todd Goldstein, Ph.D., at Northwell Health System's 3D Design and Innovation Lab in New York City. The city was the U.S. epicenter of virus infection at the time," she said. "In a matter of days, we came up with 12 designs and printed three to test on ourselves."

The final prototype, developed using FormLabs printers and surgical grade resin, was sent to infectious disease specialists at both USF and Northwell for validation testing.

"We needed to determine that the 3D NP swab could gather enough viral cells and hold them for up to three days, and that the resin would not interfere with test results," she said.

To compare the performance of the 3D NP swab with the flocked swab, the USF Health team initiated a clinical trial at numerous sites including Tampa General Hospital, Northwell Hospital and Thomas Jefferson University Hospital in Philadelphia.

At the three trial sites, 291 patients (ages 14-94) who were hospitalized or seen in the emergency room were tested for COVID-19 using both the flocked swab and 3D swab. The 3D swab displayed statistically identical results to the flocked swab in the head-to-head trial.

"The results were overwhelmingly positive," Dr. Decker said. "The clinical trial showed that the 3D nasal swabs performed as well as - or, in some cases, better than - flocked swabs."

Tampa General Hospital adopted the 3D NP swab as its standard of care and began printing more than 300 swabs a day for the hospital and its affiliated care centers. The hospital's six printers continue to print about 9,000 swabs per week.

The 3D printing process takes up to 15 hours depending on the printer. The printed swabs are rinsed in isopropyl alcohol, cured and hand-inspected for defects. Finally, a member of the hospital's infectious disease team examines each swab before it is sterilized in an autoclave and packed in a test kit.

USF filed for a provisional patent on the 3D NP swab and provided the design files and clinical data at no cost to hospitals, clinics and licensed medical device companies around the world.

"We wanted to get this swab in as many hands as possible to help slow the spread of the virus," Dr. Decker said. "This is the result of many people working together to make one device to help others."

Dr. Decker notes that the project was initiated and developed through collaborations established in the RSNA 3D Printing Special Interest group.

"Medical 3D printing is housed in the field of radiology, and RSNA and the 3D Printing Special Interest Group give us a voice," she said. "This project shows novel ways that radiology departments around the world can directly impact hospitals and clinical care during a crisis like COVID-19."

Since methods for genetic paternity analyses were introduced it became clear that many pair-living animal species, including humans, do not take partnership fidelity that seriously. In most species there is some proportion of offspring that is not sired by their social father. Coppery titi monkeys living in the Amazon lowland rainforest seem to be an exception. Scientists from the German Primate Center (DPZ) - Leibniz Institute for Primate Research in Göttingen could not find evidence for extra-pair paternity in their study population in Peru. Mate choice seems to be so successful that a potential genetic advantage does not outweigh the social costs of infidelity (Scientific Reports).

Offspring resulting from extra-pair copulations but raised by the social partner are surprisingly common in pair-living species. Various reasons are discussed for this behavior. For instance, mate choice is often limited and sometimes it only turns out later that the chosen partner is not the genetically best one. In order to ensure the best possible genes for your own children, you may use the genes of a neighbor or a floating male without giving up the security of your own territory and the caring social father.

Coppery titi monkeys live in small family-groups, consisting of male, female and offspring, who defend a territory. Usually, a single infant is born per year, that leaves the group when it reaches sexual maturity or shortly after and searches a partner, with whom it occupies an own territory. The pair-partners maintain a strong relationship, spend day and night in close proximity and groom each other. Fourteen groups of coppery titi monkeys were studied at the field station of the German Primate Center "Estación Biológica Quebrada Blanco" and its surroundings in northeastern Peru. Forty-one individuals could be genotyped using faecal samples from which DNA was extracted and sequenced at the Genetics Laboratory of the German Primate Center in Göttingen. None of the 18 offspring examined were not sired by the social father, i.e. genetic monogamy could be confirmed. In addition, it turned out that the adult animals showed a high genetic diversity and that the mating partners were on average unrelated. "Extra-pair breeding would therefore not have provided a genetic advantage for the animals studied, so that they presumably rather avoided the risks of 'infidelity'," says Sofya Dolotovskaya, who studied the animals and their behavior for 14 months of field research as a doctoral student of the German Primate Center.

"In an undisturbed ecosystem, as at our field station, young coppery titi monkeys obviously migrate far enough from their natal group to find a suitable partner without incurring the risk of inbreeding," Eckhard W. Heymann, scientist at the German Primate Center and head of the field station in Peru, concludes from the study. "Further studies must show whether genetic monogamy also prevails in other populations of coppery titi monkeys, especially in fragmented habitats".

Japanese scientists have stumbled onto a simple method for controlling the introduction of defects, called 'vacancy layers', into perovskite oxynitrides, leading to changes in their physical properties. The approach, published in the journal Nature Communications, could help in the development of photocatalysts.

Oxynitrides are inorganic compounds formed of oxygen, nitrogen and other chemical elements. They have gained much attention in recent years because of their interesting properties, with applications in optical and memory devices, and in photocatalytic reactions, for example.

In 2015, solid state chemist Hiroshi Kageyama of Kyoto University's Institute for Integrated Cell-Material Sciences (iCeMS) and his team reported that they found a way to fabricate oxynitrides using a lower temperature ammonia treatment process than the conventional method that requires more than 1,000°C). The new process produced a polycrystalline powder with layers of missing oxygen atoms, known as oxygen-vacancy planes.

The team wanted to examine the physical properties of this oxynitride, so they grew it as a single crystal thin film on a substrate. "But the oxygen-vacancy layers in the resulting film were in a different plane than the original powder," Kageyama says. They wondered if the underlying substrate influenced the orientation of the oxygen vacancy layers.

The team grew a film of strontium vanadium oxide (SrVO3) on different substrates and treated it in ammonia at a low temperature of 600°C. The plane of the oxygen vacancy layers and their periodicity--how frequently they appear within the film's other layers--changed depending on the degree of mismatch between the 'lattice strains' in the substrate and the overlying film. Lattice strain is a force applied by the substrate that causes the atoms in a material to be slightly displaced relative to their normal position.

"Even though solid state chemists have known that oxygen-defect planes play an important role in changing the properties of oxides, such as inducing superconductivity, we haven't been able to control their formation before," Kageyama says.

Oxides are typically synthesized using high temperature reactions, making it difficult to control their crystal structures. Using a lower temperature and strain in this experiment was key for success.

"Our team developed a method to create and control the direction and periodicity of the oxygen-vacancy layers in thin film oxides simply by applying strain," Kageyama says. "Since the strain energy is enormously large, as large as thousands of degrees Celsius, we're able to use it to stabilize novel structures that don't otherwise form."

Kageyama says it would be interesting to investigate how changes to the thickness of the oxide film, or the reaction temperature and time, could also affect the orientation and periodicity of the oxygen-vacancy layers.

Scientists have discovered how drug-like small molecules can regulate the activity of therapeutically relevant ion channels - and their findings could transform ongoing drug development efforts.

A major mechanism by which cells communicate with their environment is the movement of metal ions through channels located within their cell membranes.

The new study by researchers at the University of Leeds, published today in Communications Biology, provides detailed insight into the regulation of TRPC5 ion channels, which allow positively charged ions such as calcium, sodium and potassium to flow in and out of cells.

TRPC5 channels are considered potential therapeutic targets for the treatment of a range of conditions, including anxiety, kidney disease and cardiovascular disease.

Led by Dr Robin Bon, Associate Professor of Chemical Biology in the School of Medicine, and Dr Stephen Muench, Associate Professor of Membrane Biology in the School of Biomedical Sciences, the study reveals how a drug-like small molecule, called Pico145, binds to the TRPC5 channel, thereby preventing the channel from opening.

Dr David Wright, first author of the study, said: "Using cryo-electron microscopy performed in the Astbury BioStructure Laboratory, we determined high-resolution structures of the TRPC5 channel in the presence and absence of Pico145. These structures show, for the first time, how Pico145 can displace a lipid bound to each of the four TRPC5 proteins. Further studies revealed the importance of individual amino acid residues in the Pico145 binding site of TRPC5."

Many diseases are linked to defects in ion channel function, so controlling the opening and closing of specific ion channels is a highly successful therapeutic strategy.

But drug discovery efforts are often hindered by gaps in understanding of how drug-like small molecules can be designed to control ion channel activity.

Dr Muench said: "It amazes me that you think you understand how a small molecule may influence the activity of a protein - and then you find something unexpected.

"The displacement of a lipid opens up some interesting new directions of research into how this important family of proteins functions at a fundamental level and how we may develop new therapies in the future."

Dr Bon said: "The opening and closing of TRPC channels is regulated by many factors, including dietary components such as lipids, minerals and antioxidants, as well as environmental toxins. Overactivity of TRPC channels is linked to a range of diseases. Therefore, small molecules that can stop TRPC channels from opening are increasingly considered as potential therapeutic agents.

"Indeed, several pharmaceutical companies now have drug discovery programmes that focus on finding new inhibitors of TRPC channels including TRPC5.

"Pico145, which was developed by a US-based pharmaceutical company, belongs to the most potent and selective class of molecules (called xanthines) to target TRPC5 and related TRPC channels.

"In Leeds, we have done a lot of work to understand how xanthines regulate TRPC channel activity. Our structures represent a break-through that may provide new, rational approaches to the development of drug candidates that target TRPC channels.

"In addition to its relevance to drug discovery, our study also provides new insights into how physiological and dietary factors such as lipids and zinc ions may regulate TRPC channels. Therefore, our work has opened up several new lines of research."

Scientists at the University of Birmingham have developed a new sensor to measure weak magnetic signals in the brain, which has the potential to increase understanding of connectivity in the brain, and detect signs of traumatic brain injury, dementia and schizophrenia.

Magnetic signals in the brain are measured by magnetoencephalography (MEG). They are easier to localise than the electrical signals measured by EEG, so they are likely to have greater utility for earlier and more accurate diagnostic techniques.

Physicist Dr Anna Kowalczyk led a team of scientists from the Quantum Gases group at the School of Physics and Astronomy and the Neuronal Oscillation group at the School of Psychology who designed a new Optically Pumped Magnetometer (OPM) sensor. These sensors, which are used in MEG laboratories, use polarized light to detect changes in the orientation of the spin of atoms when they are exposed to a magnetic field.

Their work is published in NeuroImage, and University of Birmingham Enterprise has filed a patent application covering the design of the new sensor and its use in medical diagnostic equipment.

The new sensor is more robust in detecting the brain signals and distinguishing them from background magnetic noise compared to commercially available sensors.

The team was also able to reduce the sensor size by removing the laser from the sensor head, and made further adjustments to decrease the number of electronic components, in a move that will reduce interference between sensors.

Benchmarking tests took place in the state-of-the-art facilities at University of Birmingham's Centre for Human Brain Health, and showed good performance in environmental conditions where other sensors do not work. Specifically, the researchers showed that the new sensor is able to detect brain signals against background magnetic noise, raising the possibility of MEG testing outside a specialised unit or in a hospital ward.

Dr Anna Kowalczyk commented: "Existing MEG sensors need to be at a constant, cool temperature and this requires a bulky helium-cooling system, which means they have to be arranged in a rigid helmet that will not fit every head size and shape. They also require a zero-magnetic field environment to pick up the brain signals. The testing demonstrated that our stand-alone sensor does not require these conditions. Its performance surpasses existing sensors, and it can discriminate between background magnetic fields and brain activity."

The researchers expect these more robust sensors will extend the use of MEG for diagnosis and treatment, and they are working with other institutes at the University to determine which therapeutic areas will benefit most from this new approach.

Neuroscientist Professor Ole Jensen, who is co-director of the Centre for Human Brain Health commented: "We know that early diagnosis improves outcomes and this technology could provide the sensitivity to detect the earliest changes in brain activity in conditions like schizophrenia, dementia and ADHD. It also has immediate clinical relevance, and we are already working with clinicians at the Queen Elizabeth hospital to investigate its use in pinpointing the site of traumatic brain injuries."

The team at the CHBH has also recently been awarded Partnership Resource Funding from the UK Quantum Technology Hub Sensors and Timing to further develop new OPM sensors.

The researchers are now seeking commercial and research partnerships that will lead to better diagnostics for neurological injury, neurological disorders such as dementia, and psychiatric disorders such as schizophrenia.

As the global coronavirus pandemic continues, scientists are not only trying to find vaccines and drugs to combat it, but also to continuously learn more about the virus itself. "By now we can expect the coronavirus to become seasonal," explains Ralf Bartenschlager, professor in the Department of Infectious Diseases, Molecular Virology, at Heidelberg University. "Thus, there is an urgent need to develop and implement both prophylactic and therapeutic strategies against this virus." In a new study, Bartenschlager, assisted by the Schwab team at EMBL Heidelberg and using EMBL's Electron Microscopy Core Facility, performed a detailed imaging analysis to determine how the virus reprograms infected cells.

Cells that become infected by SARS-CoV-2 die rather quickly, within only 24 to 48 hours. This indicates that the virus harms the human cell in such a way that it is rewired and essentially forced to produce viral progeny. The main aim of the project was therefore to identify the morphological changes within a cell that are inherent to this reprogramming. "To develop drugs which suppress the viral replication and thereby the consequence of the infection, as well as the virus-induced cell death, is key to have a better understanding of the biological mechanisms driving the virus' replication cycle," explains Bartenschlager. The team used the imaging facilities at EMBL and state-of-the art imaging techniques to determine the 3D architecture of SARS-CoV-2-infected cells, as well as alterations of cellular architecture caused by the virus.

The team was able to create 3D reconstructions of whole cells and their subcellular compartments. "We are providing critical insights into virus-induced structural changes in the studied human cells," explains Ralf Bartenschlager. The images revealed an obvious and massive change in the endomembrane systems of the infected cells - a system that enables the cell to define different compartments and sites. The virus induces membrane changes in such a way that it can produce its own replication organelles. These are mini replication compartments where the viral genome is amplified enormously. To do this, the virus requires membrane surfaces. These are created by exploiting a cellular membrane system and creating an organelle, which has a very distinct appearance. The scientists describe it as a massive accumulation of bubbles: two membrane layers forming a big balloon. Within these balloons - which form a very shielded compartment - the viral genomes are multiplied and released to become incorporated into new virus particles.

This striking change can be seen in the cells only a few hours after infection. "We saw how and where the virus replicates within the cell, and how it hijacks its host machinery to be released after multiplication," Schwab says. Until now, little was known about the origin and development of the effects that SARS-CoV-2 causes in the human body. This includes a lack of knowledge about the mechanism by which the infection leads to the death of infected cells. Having this information now will foster the development of therapies reducing virus replication and, thus, disease severity.

The team has made sure that the collected information and, in particular, the unprecedented repository of 3D structural information about virus-induced substructures can be used by everyone. "I believe we are setting a precedent on the fact that we are sharing all data that we produced with the scientific community. It represents an impressive resource to the community," says Yannick Schwab. "This way we can support the global effort to study how SARS-CoV-2 interacts with its host." The team hopes that their collected information will help in the development of antiviral drugs.

The team managed to produce the study in an incredibly short time, despite the challenging circumstances. "Half the world - and of course Heidelberg as well - were in full lockdown and we had to improvise almost on a daily basis to adapt to the situation. Whether at EMBL or from home, all were deeply involved and generously gave their time and deep knowledge," says Schwab. "The speed at which we worked, and the amount of data that was produced, is remarkable."

Differential geometry is the study of space geometry. Multiple natural phenomena, from the universe expansion to thermal expansion and contraction, can come down to spatial evolution. The two core conjectures in this field, Hamilton-Tian conjecture and the Partial C0-conjecture, had remained as puzzles for more than 20 years.

"Most of the pebbles on the beach are round. They might have had edges and corners at first, but as time goes by and the tide ebbs and flows, their shape will get closer and closer to perfection and standard. But no matter how perfect the evolution is, there might still be some abnormalities, which are called 'singularities' in geometry."

"The Hamilton-Tian Conjecture is that most of the space is perfect, while the size of the 'singularity' can be restricted to a low-dimensional space", introduced by Prof. CHEN Xiuxiong, the founder of the Institute of Geometry and Physics, University of Science and Technology of China (USTC) of the Chinese Academy of Sciences (CAS).

Prof CHEN, alongside with Prof. WANG Bing from USTC, first proved the aforementioned two conjectures.

Their paper was split into two parts, the first of which was published in 2017, and the second part of 123 pages was published this year on Journal of Differential Geometry, one of the leading publications in the field of geometry which also published Hamilton's fundamental work about Ricci flow, after a long course of 5 years of developing the theory and 6 years of peer-reviewing since its first submission.

This work emphasized on the weak compactness theory for non-collapsed Ricci flows. It introduced many innovative thoughts and methods, which contributed far-reaching implications in the field of geometric analysis, especially for the studies of Ricci flows.

In fact, many other works have been developed based on this article. For example, a new solution for stability of Yau's conjecture based on the structure theory of Ricci flows was given by Prof. CHEN, Prof. WANG and Dr. SUN Song of USTC with their derivation published in the top journal, Geometry and Topology. Before that, they were rewarded Oswald Veblen Prize in Geometry for their provision of the first solution of stability of Yau's conjecture.

The theory and methods presented in this article were also applied into a series of works of Prof. WANG and his cooperators in recent years.

The core ideas of this article were generalized to the research of mean curvature flow by Prof. WANG and Prof. LI Haozhao, who solved the extension problem, and the result was published in Inventions Mathematicae.

The cooperated paper by Prof. WANG, Dr. HUANG Shaosai, and Dr. LI Yu, On the Regular-Convexity of Ricci Shrinker Limit Spaces, published on Crelle's Journal, has proved that the limit of non-collapsed shrinking Ricci solitons must be the cone shape defined by Prof. CHEN and Prof. WANG.

Besides, the work, Heat Kernel on Ricci Shrinkers published on Calculus of Variations and Partial Differential Equations by Prof. WANG and Dr. LI, developed several estimates through the study of the heat kernel on Ricci shrinkers, and provided "necessary tools to analyze short time singularities of the Ricci flows of general dimension".

This breakthrough was honored by the reviewer of the journal and the winner of Fields Metal, Prof. Simon Donaldson, who commented, "this work is a major breakthrough in geometric analysis, and it no doubt will lead many other related research projects."

The organic-inorganic hybrid perovskites (OIHPs) have a multiple application on solar cells, lighting-emitting diodes (LEDs), field effect transistors (FETs) and photodetectors. Among the parameters valuing the power conversion efficiency (PCE) of devices based on perovskite materials, the mobility of carriers undoubtedly captures a high weight.

Although researchers have made massive progress by introducing new components into the structure to control the mobility of the carriers, the understanding on the atom level about how the component affects the performance is still unknown.

To solve the problem, the research team led by Prof. LUO Yi and Prof. YE Shuji from the University of Science and Technology of China (USTC) of the Chinese Academy of Sciences (CAS) synthesized a series of 2D OHIPs films with large organic spacer cations.

By a sequence of measurements, including sum frequency generation vibrational spectroscopy (SFG-VS), optical-pump terahertz-probe spectroscopy (OPTPS), current voltage (I-V) measurements, temperature-dependent PL spectroscopy and X-ray diffraction (XRD) measurements, the researchers found the correlation among the conformation of the organic cations, the charge-carrier mobility and broadband emission.

Mobility and broadband emission showed strong dependence on the molecular conformational order of organic cations. The gauche defect and local chain distortion of organic cations are the structural origin of the in-plane mobility reduction and broad emission in 2D OIHP films. The interlayer distance and the conformational order of the organic cations co-regulate the out-of-plane mobility.

The result was published in Nature Communications on Oct. 30.

This work provides a physical understanding of the important role of organic cation conformation in optimizing the optoelectronic properties of 2D OIHPs, revealing the structure-property relationship in the perovskite research at the molecular level.

Siberian primrose, a species protected under the Habitats Directive of the European Union, spread northward from southern areas to the current Bothnian Bay as well as, through another route, to northern Norway with the gradually receding ice after the Ice Age. Compared to today, the warming of the climate was very slow at the time.

"Siberian primrose is specialised in growing on seashore meadows with low vegetation, which in Finland are formed by the post-glacial isostatic rebound. The species benefits from the lack of strong competitors and grazing that keeps the vegetation low," says Marko Hyvärinen, director of the Botany Unit of the Finnish Museum of Natural History, University of Helsinki.

In 2013, researchers at the Universities of Helsinki and Oulu planted both the Norwegian and Finnish varieties (Primula nutans ssubp. finmarchicha var. finmarchica and var. jokelae) at five different botanic gardens: in their home environments in Svanvik, northern Norway, and in Oulu, northern Finland, as well as in Rauma and Helsinki further south in Finland and in Tartu, Estonia.

As expected by the researchers, both varieties fared poorer in the southern gardens compared to Oulu and Svanvik, indicating that a warmer climate may be fatal for the species if it is incapable of adapting or relocating.

"We were surprised, however, by our finding that the Finnish populations were more successful in northern Norway than in Oulu - even more successful than the Norwegian variety there, in its home environment," says Postdoctoral Researcher Maria Hällfors from the Research Centre for Ecological Change at the Faculty of Biological and Environmental Sciences, University of Helsinki.

"This indicates that global warming already affects this plant species. We can only speculate how many other species are suffering from changes to their environment, if they, too, are unable to keep up with climate change," Hällfors says.

The researchers suggest that the poor adaptability of Siberian primrose in relation to global warming may contribute to the demise of these populations.

"Siberian primrose has no natural dispersal route further north. One way to help species like this to survive current and future challenges would be to relocate them, by human hand, further north. In other words, species could be protected by what is known as assisted migration," Hällfors contemplates.

Another option is to ensure that species have sufficiently large high-quality habitats to preserve populations at a viable level. This would ensure enough genetic variation within the populations, that is, different individuals that have a higher probability to posit characteristics that are suitable in the new conditions.

"In any case, investments in ex situ conservation, or the conservation of species outside their natural habitat, are needed. As an example, seeds of a species can be stored in a seed bank from where the species could be re-introduced to nature." Hällfors notes.

The risk of death is high for people who visit the emergency department (ED) for alcohol use, and the risk increases with frequency, according to a new study in CMAJ (Canadian Medical Association Journal) http://www.cmaj.ca/lookup/doi/10.1503/cmaj.191730.

Alcohol is a major cause of disease and death worldwide. In Canada alone, hospital admissions for alcohol-related conditions outnumber those for heart attacks, and alcohol-related harms cost about $14.6 billion annually, with $3.3 billion in health care costs.

The study included people aged 16 years and older who had at least 2 ED visits for mental and behavioural issues related to alcohol within a 12-month period between January 2010 and December 2016. It included 25 813 people, of whom two-thirds (17 020) had 2 ED visits within 1 year, 22% (5704) had 3 or 4 visits, and 12% (3089) had 5 or more visits.

For people with 2 or more alcohol-related ED visits in a 12-month period, 1 in 20 would die within a year of their last ED visit. For people with 5 or more visits, the risk of death doubled.

More than two-thirds of people with 5 or more alcohol-related visits were male (71.5%), almost half (46.5%) were aged 45-64 years, and the majority (89.6%) lived in urban centres, with 40% of those coming from the lowest-income neighbourhoods.

"Our study shows a high mortality rate in relatively young, mostly urban, lower-income individuals with frequent alcohol-related ED visits," says Dr. Paul Kurdyak, senior author and scientist at ICES and the Centre for Addiction and Mental Health (CAMH). "These visits should be seen as critical opportunities for intervention on a high-risk population to reduce avoidable mortality."

The majority of deaths were from accidental poisoning, suicide and trauma, as well as diseases of the digestive system.

The authors urge more action to support this vulnerable population and save lives.

"A combination of high mortality and low hospital admission rates suggests that frequent emergency department visits in this population signal an unmet need. Given our cohort's relatively young age, effective interventions have the potential to prevent premature mortality and reduce hospital use," conclude the authors.

Social needs--such as food and economic insecurity, poor housing and neighborhood conditions, and lack of access to transportation--were common in a group of African American cancer survivors in Detroit, and they were associated with lower health-related quality of life (HRQOL). The findings are published early online in CANCER, a peer-reviewed journal of the American Cancer Society (ACS).

Among cancer survivors, HRQOL--or individuals' perceived well-being regarding their mental, physical, and social health status--tends to be significantly lower among African Americans compared with other groups. Investigators looked to see if social needs may play a role in this disparity.

The analysis included 1,754 participants in the Detroit Research on Cancer Survivors (ROCS) cohort, a population-based study of African American survivors of breast, colorectal, lung, and prostate cancer. Social needs related to food insecurity, utility shut-offs, housing instability, not getting health care due to cost or lack of transportation, and negative perceptions of neighborhood safety. HRQOL was measured using a questionnaire called the Functional Assessment of Cancer Therapy-General (FACT-G).

Researchers found that more than one-third (36.3 percent) of survivors reported social needs, including 17.1 percent who reported two or more. Prevalence of social needs ranged from 8.9 percent for utility shut-offs to 14.8 percent for food insecurity. Social needs that were linked with a low HRQOL score in the FACT-G questionnaire included not getting care due to lack of transportation, housing instability, food insecurity, feeling unsafe in the neighborhood, utility shut-offs, and not getting care due to cost.

Lead author Theresa Hastert, PhD, of the Karmanos Cancer Institute and Wayne State University School of Medicine in Detroit, noted that a link between social needs and lower HRQOL among cancer survivors is not surprising; however, the association had not been quantified before. Additionally, the study was conducted in a population of African American cancer survivors, a population that is often underrepresented in cancer research. The prevalence of social needs in this population may be higher than in cancer survivors more broadly; however, the results likely apply to other populations as well.

"My hope is that these findings raise awareness among cancer care providers and cancer researchers that many patients face substantial social and financial difficulties and that these have real impacts on patients' health-related quality of life on top of cancer and cancer treatment," Dr. Hastert said. "Cancer care and survivorship settings may represent an opportunity to screen for social needs, to connect patients and survivors with programs and services to address those needs, and to implement innovative interventions to reduce health disparities by addressing social needs among Black cancer survivors. These findings also highlight the need for and importance of having a social safety net in advancing population health and health equity."

OVER-45s are at a higher risk of contracting STIs than ever before because of society's unwillingness to talk about middle-aged and older people having sex, a new report has found.

A study undertaken by the University of Chichester, alongside organisations in the UK, Belgium, and Netherlands, revealed negative attitudes and limited knowledge towards the age group's sexual health needs is associated with a generation unaware of the dangers of unprotected intercourse.

It also found that over-45s living in socially and economically-disadvantaged areas are at particularly risk of contracting sexually-transmitted infections with little awareness of available healthcare services and limited access to doctors and nurses.

The report is part of the SHIFT project: a three-year initiative which aims to develop a training model that can be used by professionals working in healthcare to improve the sexual health and wellbeing of middle-aged and older people across the UK and Europe.

University of Chichester senior lecturer Dr Ian Tyndall, who is leading the project's evaluation, said that major changes in sexual behaviour in recent decades has seen increasing numbers of sexually active older-people.

"Over-45s at most risk are generally those entering new relationships after a period of monogamy, often post-menopause, when pregnancy is no longer a consideration, but give little thought to STIs," he added. "Given improvements in life expectancy, sexual healthcare needs to improve its intervention for older adults and vulnerable groups to provide a more utilised, knowledgeable, compassionate, and effective service."

The three-year SHIFT study was launched in 2019. Following a 2.5million grant from the EU Interreg 2Seas programme, its intention is to address growing rates of STIs in over-45s and improve engagement of older people in sexual health services, including those facing socioeconomic disadvantage.

The latest SHIFT report included around 800 participants across the south coast of England and northern regions of Belgium and the Netherlands, nearly 200 of which face socioeconomic disadvantage. Initial findings have highlighted four critical areas where, the researchers believe, an intervention can address the gaps in current healthcare provision: awareness, access, knowledge, and stigma.

Awareness: The results showed that a significant number of participants were unaware of the risks of STI, while 46 per cent did not know the location of their nearest healthcare centre. Researchers did, however, find that social media was the most effective tool for encouraging engagement with sexual health services - ahead of leaflets or GP appointments.

Knowledge: The participants highlighted that their health professionals, including doctors and nurses, lacked sufficient sexual health knowledge - and consequently only half had a recent STI test. There is therefore an "urgent need" to create a tailored training programme to increase understanding in the wider healthcare workforce, the researchers wrote.

Stigma: Shame was identified as the biggest barrier to accessing sexual healthcare services, according to the report. A number of participants felt that sexual health has become a "dirty" term which is discouraging people from attending regular check-ups.

Access: Limited information around the location of sexual health centres and restricted opening times were a consistent problem for many participants. Others living in more rural locations also mentioned that growing costs of public transport was a barrier to appointments.

Fellow SHIFT researcher Dr Ruth Lowry added: "It is clear from the numbers reporting fear of being judged by important others who know them and by health professionals that stigma remains a crucial barrier to address in any sexual health promotion intervention.

"The findings have also shown that groups with one or more socio-economic disadvantages, such as homeless people, sex workers, non-native language speakers and migrants, are at even greater risk of being unaware of their sexual health and unable to access the appropriate services."

The SHIFT partners intend to have an effective intervention ready by 2021, after which it will be rolled out to healthcare professionals, with the research published in 2022. It intends to reach as many as 150,000 people across the south coast of the UK, France, Belgium, and the Netherlands.

The survey was distributed prior to the Covid-19 pandemic, while focus groups and interviews are taking place via video calls to navigate restrictions in jurisdictions across participating countries.

To find out more about the SHIFT project go to http://www.interreg2seas.eu/en/shift.

The World Health Organization developed the new Labour Care Guide to support clinicians in providing good quality, women-centred care during labour and childbirth. In a study published in Birth, researchers evaluated the usability, feasibility, and acceptability of the new Labour Care Guide for maternity care providers in six countries.

The guide is a next-generation partograph--a paper-based graphical record of key maternal and fetal data during labour. For the study, 136 doctors, midwives, and nurses in 12 health facilities across Argentina, India, Kenya, Malawi, Nigeria, and Tanzania applied the Labour Care Guide in managing labour and birth in 1,226 low-risk women.

Most women (91.6%) had a spontaneous vaginal birth, and two cases of stillbirths (1.63 per 1,000 births) occurred. Providers were highly satisfied with the Guide, and they identified some design improvements to improve its usability. Providers described it as supporting precise and meticulous monitoring during labour, encouraging critical thinking in labour management, and improving the provision of woman-centred care.

"We successfully demonstrated that the World Health Organization's Labour Care Guide can be used to support women-centred care in a range of settings, including settings where resources are somewhat limited," said corresponding author Dr. Joshua Vogel, PhD, MBBS, of the Burnet Institute, in Australia.

A team led by researchers at Baylor College of Medicine and Rice University has developed artificial intelligence (AI) models that help them better understand the brain computations that underlie thoughts. This is new, because until now there has been no method to measure thoughts. The researchers first developed a new model that can estimate thoughts by evaluating behavior, and then tested their model on a trained artificial brain where they found neural activity associated with those estimates of thoughts. The theoretical study appears in the Proceedings of the National Academy of Sciences.

"For centuries, neuroscientists have studied how the brain works by relating brain activity to inputs and outputs. For instance, when studying the neuroscience of movement, scientists measure muscle movements as well as neuronal activity, and then relate those two measurements," said corresponding author Dr. Xaq Pitkow, assistant professor of neuroscience at Baylor and of electrical and computer engineering at Rice. "To study cognition in the brain, however, we don't have anything to compare the measured neural activity to."

To understand how the brain gives rise to thought, researchers first need to measure a thought. They developed a method called "Inverse Rational Control" that looks at a behavior and infers the beliefs or thoughts that best explain that behavior.

Traditionally, researchers in this field have worked with the idea that animals solve tasks optimally, behaving in a way that maximizes their net benefits. But when scientists study animal behavior, they find that this is not always the case.

"Sometimes animals have 'wrong' beliefs or assumptions about what's going on in their environment, but still they try to find the best long-term outcomes for their task, given what they believe is going on around them. This could account for why animals seem to behave suboptimally," said Pitkow, who also is a McNair Scholar at Baylor, co-director of Baylor's Center for Neuroscience and Artificial Intelligence and member of the Rice Neuroengineering Initiative.

For example, consider an animal that is hunting and hears many noises it associates with prey. If one potential prey is making all the noises, the optimal behavior for the hunter is to consistently target its movements to a single noise. If the hunter mistakenly believes the noises are coming from many different animals, it may choose a suboptimal behavior, like constantly scanning its surroundings to try and pinpoint one of them. By acting according to its belief or assumption that there are many potential prey nearby, the hunter is behaving in a way that is simultaneously 'rational' and 'suboptimal.'

In the second part of the work, Pitkow and his colleagues developed a model to relate the thoughts that were identified using the Inverse Rational Control method to brain activity.

"We can look at the dynamics of the modeled thoughts and at the dynamics of the brain's representations of those thoughts. If those dynamics run parallel to each other, then we have confidence that we are capturing the aspects of the brain computations involved in those thoughts," Pitkow said. "By providing methods to estimate thoughts and interpret neural activity associated with them, this study can help scientists understand how the brain produces complex behavior and provide new perspectives on neurological conditions."

Below please find a summary and link(s) of new coronavirus-related content published today in Annals of Internal Medicine. The summary below is not intended to substitute for the full article as a source of information. A collection of coronavirus-related content is free to the public at http://go.annals.org/coronavirus.

1. Type O and Rh negative blood groups associated with slightly lower risk for SARS-CoV-2 infection

A person's blood type may affect their risk for SARS-CoV-2 infection and for developing severe COVID-19-related illness. A population-based retrospective cohort study is published in Annals of Internal Medicine.

Researchers from ICES in Toronto studied 225,556 persons who had an ABO blood group test from January 2007 to December 2019, and had a SARS-CoV-2 lab test subsequently to determine whether ABO and Rh blood groups are associated with risk for SARS-CoV-2 infection and severe COVID-19 illness. The population-based study was conducted in Ontario Canada, which has universal health care and widespread SARS-CoV-2 testing. The authors found that O and Rh? blood groups were associated with a slightly lower risk for SARSCoV-2 infection as well as severe COVID-19 illness or death. The authors wonder whether similar differences will be seen within ongoing clinical trials studying the therapeutic efficacy of SARS-CoV-2 immunotherapy or vaccination. Read the full text: https://www.acpjournals.org/doi/10.7326/M20-4511.

Media contacts: A PDF for this article is not yet available. Please click the link to read full text. The lead author, Joel Ray, MD, MSc, can be reached through Deborah Creatura at deborah.creatura@ices.on.ca.

2. If licensed soon, a SARS-CoV-2 vaccine would be an unprecedented achievement

The development of a safe and effective vaccine for SARS-CoV-2 is a crucial global health goal, but anticipated success rates and timelines for COVID-19 vaccine development vary.

Researchers from McGill University reviewed trials testing viral vaccines that had not advanced to phase 2 between January 2005 and March 2020 on ClinicalTrials.gov, and tracked the progress of each vaccine from phase 1 through to FDA licensure to estimate timelines and probabilities of success for recent vaccine candidates. Ultimately, they found success probabilities and timelines varied widely across different vaccine types and diseases. If a SARS-CoV-2 vaccine is licensed within 18 months of the start of the pandemic, it will mark an unprecedented achievement for noninfluenza viral vaccine development. The findings are published in Annals of Internal Medicine. Read the full text: xhttps://www.acpjournals.org/doi/10.7326/M20-5350.

Media contacts: A PDF for this article is not yet available. Please click the link to read full text. The lead author, Jonathan Kimmelman, PhD, can be reached at jonathan.kimmelman@mcgill.ca.

3. Surviving COVID-19 patients may benefit from home health care after hospital discharge

Survivors of COVID-19 are a vulnerable population and may require further hospitalization, but little is known about recovery after hospital discharge. Authors from the University of Pennsylvania Schools of Nursing and Medicine, Villanova University Fitzpatrick College of Nursing, and the Visiting Nurse Service of New York describe the home health recovery of patients with COVID-19 and risk factors associated with rehospitalization or death.

The researchers studied 1,409 patients with COVID-19 admitted to home health care (HHC) after hospitalization. After an average of 32 days in HHC, 94 percent of patients were discharged and most achieved statistically significant improvements in symptoms and function. These findings suggest that acute care providers might carefully consider which COVID-19 survivors would benefit from HHC after hospitalization. They call for further research to determine longer-term outcomes of CO VID-19 and to target extra attention to patients with risk factors. The findings are published in Annals of Internal Medicine. Read the full text: xhttps://www.acpjournals.org/doi/10.7326/M20-5206.

Media contacts: A PDF for this article is not yet available. Please click the link to read full text. To speak with the lead author, Kathryn H. Bowles, BSN, MSN, PhD, please contact Ed Frederico at efed@nursing.upenn.edu. To speak with someone from the Visiting Nurse Service of New York, please contact Caren Browning at caren.browning@kingcompr.com. To speak with someone at Penn Medicine, please contact Holly Auer at Holly.Auer@pennmedicine.upenn.edu. To reach someone at Villanova, please email Ann McKenzie at ann.mckenzie@villanova.edu or Carita Geib at carita.geib@villanova.edu.